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<br /> �' � c WOOD BURNING EOUIPMENT '�` - - ' �`�;
<br /> .� �� �� �
<br /> �" � Wood stove with flue ��. `�'� �
<br />� �� � �:; : ��;
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<br /> _� � ,�� � � ° Wood combination or add-on `;� r y ra �� ,��_� n
<br /> , .:
<br /> Factory fireplace with flue - r�
<br /> � Factory Fireplace (s) Freestanding Masonry t�
<br /> Wood Stove (s) Franklin, other �'
<br /> °�
<br /> � Brand Name Model No. �y
<br /> �_�� Mfgr's Min., Clearances, side , rear , min. flue dia. ���
<br />�:�"
<br /> '� VENTII.ATION � .
<br /> No. l Kitchen Exhaust ducted recirculating cfm
<br /> No. (p Bath Exhaust (must be ducted outside) cfm
<br />�, ,�,:� No. Other Fans: Locations cfm
<br /> ,,�� = �
<br /> ; -�� ` � �- FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
<br />� Installation Removal ;_
<br />��
<br /> a ° Fuel oil: gallons underground inside outside
<br />,�.
<br />�:�:�` LP Gas: gallons
<br />,���� Other Gas opening
<br />��;
<br />��� �' PERMIT FEE CALCULATION
<br /> E�� _
<br /> � ; 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ��,
<br /> 4�,
<br />,��, �� � �t{., ac, x .0125 $ �i�'Y� . S�
<br /> (contract price) t-,
<br />� °�f 2. State Surcharge. ** Add the State Building Code Division .�:
<br /> ` {. Surcharge to each permit. 1 g 'a �ti.a� x .0005 $ 3� �� '`
<br /> , �f, .
<br />�-,�-,�t�.: or $.50, whichever is greater (contract price) ��
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<br />�� �
<br />���,," 3. Posta�e and Handling (Only mail-in applications) $ 1.50
<br /> x`� '� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ t 6 1 '1 . (o�;
<br /> s�
<br />�� �:`4� ' ' * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br />��t work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br /> � a • ' ' :; customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, '
<br />�� � �:i t '` tenant or any other party the reasonable market value of such items must be added to the esttmated cost
<br />�,`�. �:h .� �', ' or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost, �.%'.� � �:
<br />��, � _,.;�, the City may request the submission of a signed copy of the actual contract. ,,
<br />�� � 3 r�
<br />��� � ,
<br /> ���, � ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is yr �
<br />����'p'�. �' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. �
<br /> �..
<br />,,�,� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do �;
<br />'��� all work in strict accordance with the ordinances of the City and the regulations of the Minnesota :�.��;
<br />�` State Building Code, and certifies that all statements made on this application are complete, true ��
<br />�r�� and conect.
<br /> �:
<br />���` �
<br />�;,. Applicant's Signature: Date: `3 � 3 - C�� `��
<br /> ,
<br /> �'
<br />��; Approved By: �
<br /> Date: �- ?�� w�
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